Delirium: Breaking From Routine Can Trouble Some Hospital Patients

Hospital stays can be stressful for anyone. Worse, though, for about seven million patients each year who suffer from delirium. It’s a sudden state of confusion that can last from hours to days and well after release.

Megan Wheeler, an adult clinical nurse specialist, has been involved in Baylor Scott White Health’s research on preventing delirium in elderly patients.

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The KERA Interview with Megan Wheeler

Interview Highlights

What we now know about delirium: The original thought was these people who come in that are so sick that they’re put on breathing machines…medically-induced comas and sedating drugs, things like that that they have a hard time coming out of it. So they were experiencing delusions and hallucinations. They used to call it "I.C.U. Psychosis." And what we found out in the late '90s, is that it happens all across the hospital.

What brings on delirium in hospitals: What we think is a lot of the time, especially with older adults, is that you take them out of their routine. We put them in a place where they don’t recognize a lot of the people, got a different nurse every 12 hours, doctors that come see you on different days. There’s always noise going on. It just disturbs there normal pattern. Severity of illness and the treatment plans that you have as well. We’re still learning about it (delirium) on a daily basis.

Do healthcare providers take delirium seriously? A lot of physicians and nurses (don’t). They’re still of that mindset. So we’re trying to break that barrier. Thirty to 40 percent of the time this is preventable. It’s something we need to look at with all our patients as they come into the hospital. So now, in our health care system, our nurses are screening every patient every shift for signs of delirium.

Make sure that hospital personnel have a complete list of all the medications the person is taking, including over-the-counter medicines.

Make things familiar for the person. Take a few family photos or other favorite things (such as a blanket, rosary, book or music tape) to the hospital.

If someone develops hospital delirium, stay with him or her in the hospital as much as possible, including at night. In addition to providing comfort and reassurance, family members are more likely than others to recognize when their loved one isn’t behaving normally or being treated appropriately.

Make sure the person has his or her eyeglasses, hearing aids, or dentures. These are often put away during a hospital stay, but that can contribute to disorientation.

Promote physical and mental activity. Help the patient get up and walk two or three times a day. Engage in quiet conversation about current events or family activities. Play card games or do crossword puzzles together.

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